Hi please can you help me with my thyroid result which was TSH 0.15 and T4 18 I’m on 75mcg Levothyroxine. Major energy slumps at times.

[clean1995]

Thyroid results

[SeasideSusie Remembering]

Clean1995

Did you do your test as we always advise:

* Test no later than 9am

* Nothing to eat or drink except water before the test

* Last dose of Levo 24 hours before the test

* If you take a Biotin supplement or B Complex did you leave this off for 3-7 days before the test

Can you please add the reference ranges for your results, particularly FT4. Ranges vary from lab to lab so we can't interpret your results without the ranges that came with them.

For a full picture of thyroid status we also need FT3 testing at the same time as TSH and FT4. FT3 is the active hormone that every cell in our body needs and low FT3 causes symptoms.

Have you ever had Thyroid antibodies tested?

We also need optimal nutrient levels for thyroid hormone to work properly so we should also test

Vit D

B12

Folate

Ferritin

If you have any of these other test results please add them, also please tell us if you take any supplements or other medication.

[clean1995 in reply to SeasideSusie]

Thanks for your reply. It was later than that, and I had eaten. I will have to get a retest and follow your guidelines. 💙

[SeasideSusie Remembering in reply to clean1995]

clean1995

The reason for not testing later than 9am is because TSH is highest early morning and lowers throughout the day. Also certain foods and caffeine containing drinks can lower TSH. So your TSH is very likely to be showing lower than normal.

The reason for leaving a 24 hour gap between last dose of Levo and the test is because if you take your Levo before the test you will be measuring a spike in the hormone level that the Levo gives so you get a false high FT4. Leaving 24 hours gives a more normal measure of circulating hormone. Leaving any longer gives a false low FT4.

Do you always take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only and water only for one hour each side, also keeping any other medication or supplements at least 2 hours away from Levo, for maximum absorption of the Levo?

[clean1995 in reply to SeasideSusie]

I take it an hour before food but not just with water. I also take Citalopram with it 🤨Thanks so much for the advice. I will amend my routine 👌

[SeasideSusie Remembering in reply to clean1995]

clean1995

Do you have the reference ranges for your tests please? I think it's likely that your dose may need to be increased but without the ranges we can't tell whether your FT4 is high or low in range.

Taking an SSRI (such as Citalopram) can mean that the therapeutic efficacy of Levothyroxine can be decreased and your dose of your of Levo may need to be increased.

How long have you been on the Citalopram?

Do you have any thyroid results from before starting the Citalopram to compare with current results to see if you are now in need of a dose increase?

As anxiety and depression can be symptoms of hypothyroidism/undermedicastion then being on the correct dose of Levo might mean that you could taper off the Citalopram.

I would keep the Citalopram as far away as possible from your Levo, maybe opposite ends of the day if possible.

[clean1995 in reply to SeasideSusie]

I was only given those 2 readings. I find the GPS I attend aren’t very helpful regarding thyroid stuff. It’s so black and white. I am going to ask them for the whole range. I have been on Citalopram for years on and off unfortunately. It’s for anxiety which I get really badly. I will look into taking it at a different time. I don’t know if I can get the other results.

[SeasideSusie Remembering in reply to clean1995]

Clean1995

Here in the UK we are legally entitled to our test results without charge or question. Ring the surgery and ask the receptionist (not the doctor) for a print out of your results. No need to give a reason, if you feel pressured to then just say it's for your own records. Don't accept hand written or verbal results, make sure it's a print out and the reference ranges should be on there at the side of the results.

[clean1995 in reply to SeasideSusie]

Yes I’ll do that. Thanks so much for all your advice 😊